Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma: Comparison with selective urine cytology sampling
Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma: Comparison with selective urine cytology sampling
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DOI：
10.1016/j.clinimag.2018.08.012
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发表时间：
2018-11-01
期刊：
影响因子：
2.1
通讯作者：
Jinzaki, Masahiro
中科院分区：
文献类型：
--
作者：
Akita, Hirotaka;Kikuchi, Eiji;Jinzaki, Masahiro
目的：评估 CT 尿路造影 (CTU) 中加入弥散加权 MRI (DW-MRI) 诊断上尿路尿路上皮癌 (UTUC) 的有效性。 材料和方法：我们回顾性评估了 102 例同时接受 CTU 和 DW-MRI 的 UTUC 高危患者。对所有患者的 CTU 和 DW-MRI 诊断性能进行了评估。然后，根据CTU表现的类型（肿块形成、壁增厚和小的充盈缺损）评估DW-MRI对CTU表现阳性患者的诊断性能。还比较了这些患者中 DW-MRI 和选择性尿细胞学取样的诊断性能。结果：DW-MRI 的敏感性 (92%) 低于 CTU (98%) (P = 0.25)，因为 DW-MRI 无法检测到任何小的乳头状肿瘤。 DW-MRI 的特异性 (91%) 高于 CTU (78%) (P = 0.065)，因为 DW-MRI 可以区分一些良性病变和 UTUC。在 59 个阳性 CTU 病灶中，DW-MRI 正确诊断了所有 41 个肿块形成病灶，并将准确率从单独使用 CTU 的 36% 提高到 14 个壁增厚病灶的 79%，但无法为 4 个小的充盈缺损病灶添加任何附加信息。在接受选择性尿细胞学取样的 44 例 CTU 阳性患者中，DW-MRI 的敏感性 (95%) 显着高于选择性尿细胞学取样 (56%) (P < 0.001)。结论：DW-MRI 的加入对于肿块形成和壁增厚病变都有用。 DW-MRI 有可能减少对此类病变进行选择性尿液细胞学采样的频率。
Objectives: To evaluate the usefulness of adding diffusion-weighted MRI (DW-MRI) to CT urography (CTU) for diagnosing upper tract urothelial carcinoma (UTUC).Materials and methods: We retrospectively evaluated 102 high-risk patients with UTUC who underwent both CTU and DW-MRI. The diagnostic performance of CTU and DW-MRI was evaluated in all the patients. Then, the diagnostic performance of DW-MRI in the patients with positive CTU findings was assessed based on the types of CTU findings (mass formation, wall thickening, and small filling defects). The diagnostic performance of DW-MRI and selective urine cytology sampling in these patients was also compared.Results: The sensitivity of DW-MRI (92%) was less than that of CTU (98%) (P = 0.25), since DW-MRI could not detect any small papillary tumors. The specificity of DW-MRI (91%) was greater than that of CTU (78%) (P = 0.065), since DW-MRI could discriminate some benign conditions from UTUC. Among the 59 positive CTU lesions, DW-MRI correctly diagnosed all 41 mass-forming lesions and improved the accuracy from 36% using CTU alone to 79% for 14 wall-thickening lesions but could not add any additional information for 4 small filling-defect lesions. Among the 44 patients with positive CTU findings who underwent selective urine cytology sampling, the sensitivity of DW-MRI (95%) was significantly greater than that of selective urine cytology sampling (56%) (P < 0.001).Conclusions: The addition of DW-MRI would be useful for both mass-forming and wall-thickening lesions. DW-MRI has the potential to reduce the frequency of selective urine cytology sampling for such lesions.